Academy Health National Health Policy Conference

Thank you, Lisa. I want to start by acknowledging our host, Academy Health. America’s health services researchers play an invaluable role in our efforts to build a more effective health care system and a healthier America.

You’re the ones who tell us where the need is greatest, which approaches are working, and when we need to go back to the drawing board. The foundation of a 21st century health care system in this country is going to be the evidence base that you’ve assembled.

I also wanted to specially acknowledge a leader who has done so much to advance health services research over the last few decades. As some of you know, Carolyn Clancy has announced that she will be leaving our department after 23 years at AHRQ, including the last ten as Director.

Carolyn’s record of accomplishment speaks for itself. She’s run AHRQ at a time when its profile has never been higher and demand for its insights has never been greater.

Under her leadership, AHRQ produced its first-ever annual reports on quality, safety, and disparities, finally giving us important benchmarks we can use to track our progress. And AHRQ-funded research has led directly to significant improvements in health outcomes in areas like health care-associated infections.

Carolyn has generously agreed to stay on until we find someone to fill her position. But today, I just want to say – on behalf of the department and millions of Americans benefitting from better, safer care – how grateful we are for her service. Thank you, Carolyn.

The last time I spoke at this conference was in 2010, a few weeks before the passage of the Affordable Care Act. Think about how far we’ve come since then.

When it comes to health insurance, consumers now have the strongest set of protections in history. More than three million young people have gained coverage through their parents’ plans. Preventive care is free for tens of millions of Americans. And seniors with the highest drug costs are getting big savings on their prescriptions.

At the same time, we’ve seen the start of a transformation in our health care delivery system. New models of care are proliferating. Already, more than two hundred and fifty health organizations, of all shapes and sizes, have agreed to form Accountable Care Organizations. That means as many as four million Medicare beneficiaries now get their care from providers whose bottom line is keeping them healthy. And these new models are spreading rapidly in states and the private market too.

In response to these changes and other new incentives, health care providers are embracing new data tools that make it easier to improve care and share information between providers and patients. Use of basic electronic health records has doubled since 2008. And more than 80 percent of hospitals have committed to being meaningful users of electronic health records by 2015.

Most importantly of all, these changes are translating into real improvements in people’s lives. For example, hospital readmissions in Medicare have fallen nationally and have dropped 25 percent or more in some communities. Meanwhile, we’ve had three years in a row of historically low growth in health care costs. While we can’t attribute this drop entirely to the law, it’s undoubtedly a positive sign.

The Affordable Care Act is the law of the land. It’s here to stay. And it is working. The wheels of progress in American health care are turning. But we’ve only just begun to see the difference this law can make.

In the coming months and years, we’ll have a huge opportunity to significantly speed up the transformation of health care in a way that will benefit all Americans. But we will need the continued efforts of partners, across the health care system and around the country, to achieve this law’s full potential.

That starts with expanding coverage to tens of millions of Americans who are currently outside the system. As you know, new marketplaces are now being built in every state that will make affordable coverage available to millions of Americans beginning January 1st. In addition, many states will be expanding their Medicaid programs.

For people without insurance, the benefits of coverage are huge. They’re more likely to get preventive care and checkups. They don’t have to weigh the cost of going to the emergency room when their five-year-old wakes up with a fever. There’s no risk of losing it all if they get seriously ill and run up a big hospital bill.

But the truth is that when our friends and neighbors can afford the health care they need, that’s not just good for them. It’s good for all of us. We all benefit when our premiums are no longer inflated with tens of billions of dollars in added costs for uncompensated care. We all benefit when workers can spend more time on the job, and kids can spend more time in school.

And one reason we need influential voices like yours to make these points is that several states are still weighing the decision about whether to expand their Medicaid programs – decisions that will affect whether millions of Americans can get coverage.

These states are being offered an incredible deal. If they expand their Medicaid programs to serve adults making up to around $1200 a month and families making up to around $2500 a month, then the federal government will pick up 100 percent of the bill for the first three years and at least 90 percent of the bill after that.

Think about that deal. In exchange for picking up a tiny fraction of the tab, states can dramatically expand health coverage for working families, increase productivity, save lives, and reduce their burden of uncompensated care. That’s as good a deal as any state is going to get, and you can help get these facts into the debate.

Merely expanding access to health insurance is not enough, however. Unless people know affordable coverage is now available to them – and unless they know how to get it – they’re going to remain on the outside of our health care system looking in.

That means over the next year we’re also going to have to reach out directly to millions of Americans who, in many cases, have not spent a lot of time in the health insurance market.

Some of these people may believe that affordable health insurance is out of reach for them. They’re so used to exorbitant premiums and insurance companies jerking them around that they’ve understandably come to believe that having coverage will never be an option.

Others are young people. If you have children in their twenties like I do, you know that health insurance is not always their top priority. I don’t always know what that priority is, but it’s not health insurance. Yet we know that young people often take the biggest risk when they go without coverage since they’re less likely to have the resources to cover care out of pocket.

If we’re going to fulfill the full promise of the Affordable Care Act and insure millions more Americans, we’ll need to reach these people. And we’ll need your help to do it.

Part of that is educating people about the new Marketplaces. They need to know that this is a whole new way to shop for health insurance. They’ll be able to submit a single application to find all the plans that fit their budget. Discrimination against pre-existing conditions will be outlawed. And there will be tax credits for working families that could save them money on their coverage right away. People can go to HealthCare.gov right now to learn more and sign up for updates to make sure they don’t miss out on new benefits.

Everyone can play a role in educating Americans about the new coverage options that are coming. If you’re a health care provider, you can start talking about them to your patients. If you’re a state or local official, you can share this information with people who seek out government services. If you’re a policy analyst, you can help identify better ways to locate the uninsured and motivate them to purchase coverage. If you’re a researcher, you can help make sure that once people get coverage, they also get the care they need, especially critical preventive services.

Many of us in this room have been arguing for decades that making health coverage affordable to all Americans is one of the best investments we can make as a nation. Now that we finally have the chance to make that happen, we need to do everything we can to make the most of it.

But the coverage expansion isn’t the only part of the law that is kicking into gear over the next year. In the years before the health care law passed, costs were rising at an unsustainable rate.

We often hear about the rising costs in Medicare and Medicaid, but it’s important to remember that this isn’t a unique characteristic of government health programs. In fact, Medicare and Medicaid costs have been growing more slowly than private insurance premiums. The driver is the growth in the underlying cost of care, which was putting equal pressure on family ledgers, corporate balance sheets, and local, state, and federal budgets.

But even though Medicare is not the problem, we knew it could be part of the solution. History shows that innovations in how we pay for care often begin with Medicare and then spread to the private insurance industry. And a critical part of the Affordable Care Act are the new payment models our department is rolling out to help health organizations change the way they deliver care.

Some of our early results have been very promising. I already mentioned the drop in hospital readmissions. We’ve also seen impressive results in our efforts to reduce health care-associated infections, with central line bloodstream infections down more than 40 percent. And in our Strong Start initiative, some participating hospitals are reporting that they’ve reduced their early elective deliveries to close to zero. That means fewer at-risk newborns and fewer admissions to the ICU, at an average cost savings of nearly $5,000 per delivery.

But for all the progress we’re seeing, change is not happening fast enough. Far too many patients still experience a health care system that is fragmented, unreliable, and often prohibitively expensive. Far too many health care providers are still content to sit back and let others blaze the trail towards a 21st century health care system. So my challenge to all of you today – and especially to the provider community – is to speed up the rate of change.

If you are already at the vanguard of transforming care, now is the time to take the next step forward. If you have been considering participating in a new care model, now is the time to take the plunge. If you have been waiting on the sidelines, now is the time to get in the game.

Health services researchers and policy analysts have a role to play. For years, you have helped identify our health care system’s biggest problems and evaluate solutions. But too often those results have come in a 200 page report five years after a study launched. We can’t afford to wait five years to find out what qualities make a successful ACO. We need that information in real time so we can use it to shape policy to have the biggest impact on people’s lives.

I want to be clear: the transformation I’ve talked about today will not happen overnight. When this conference convenes next February, there will still be uninsured Americans we need to cover. There will still be rising costs we need to control. There will still be models of care that need to be evaluated.

But we have a rare opportunity over the next year to make huge strides together in transforming our health care system. If we can take advantage of that opportunity, the payoff for the American people in better care, better health, and lower costs will be enormous.